The prognostic significance of the comprehensive complication index in patients with gastric cancer

Postoperative complications worsen the prognosis of gastric cancer patients. The Clavien–Dindo classification is used to evaluate postoperative complications. The prognostic significance of the comprehensive complication index (CCI), a new tool for evaluating postoperative complications, remains unclear.

This study included 452 gastric adenocarcinoma patients who underwent curative surgery.

The CCI values were significantly higher in older patients ( ≥ 70 years; P < 0.0001), male patients (P < 0.0001), those with lymphatic invasion (P = 0.039), and those with vascular invasion (P = 0.037). The five-year overall survival (OS) and disease-specific survival (DSS) rates were significantly higher in patients without postoperative complications and those with Clavien–Dindo grade 1 complications in comparison to those with Clavien–Dindo grade 2–4 complications (80.4% vs. 66.2%, P = 0.0011; 89.7% vs. 82.3%; P = 0.045, respectively). Among patients with Clavien–Dindo grade 2–4 complications, the 5-year OS and DSS rates in the CCI^High group ( ≥ 32.15) were significantly lower than those in the CCI^Low group ( < 32.15; 47.5% vs. 74.9%, P = 0.0086; 63.1% vs. 90.0%, P = 0.0003). A multivariate analysis identified the CCI as an independent prognostic indicator in patients with Clavien–Dindo grade 2–4 complications.

The CCI was closely associated with the prognosis of patients with Clavien–Dindo grade 2–4 complications and may be a prognostic indicator.